Determinants of geriatric patients’ quality of life after stroke rehabilitation

Objectives: Geriatric patients’ physical disabilities, dependency on care, and possible psychological ill-being may negatively affect both the patient's quality of life and the informal caregiver burden. Focusing on this interrelationship which can be particularly prominent in geriatric patients with stroke, the objective of this study was to identify determinants of patients’ quality of life and informal caregiver burden.

Method: This is a prospective, multicentre, cohort study. Data were collected in 84 geriatric home-dwelling patients with stroke three months after their rehabilitation period in skilled nursing facilities (SNFs). We assessed patients’ quality of life, depressive complaints, neuropsychiatric symptoms, balance, (instrumental) activities of daily living, and informal caregiver burden. Linear regression models were constructed to study the association between the variables.

Results: For several domains, high quality of life of these geriatric patients was associated with high functional independence, less neuropsychiatric symptoms, and less depressive complaints. Informal caregiver burden was not associated with patients’ quality of life, but patients’ neuropsychiatric symptoms were a significant determinant of high informal caregiver burden.

Conclusion: The presence of neuropsychiatric symptoms (more specifically depressive complaints) negatively affects the quality of life of geriatric patients. Their neuropsychiatric symptoms also affect caregiver burden. Health care professionals in SNFs can play an important role in providing the necessary psychosocial support and aftercare.     

The relationships among perceived discrimination,self-perceptions of aging,and depressive symptoms: a longitudinal examination of age discrimination

Objectives: This study examined the relationship between changes in perceived discrimination and changes in depressive symptoms among older people. The association between perceived age discrimination and depressive symptoms was also analyzed longitudinally along with tests to determine whether self-perception of aging mediates this association.

Method: Data from two waves (2008 and 2012) of the Health and Retirement Study were used. Longitudinal models were tested using a nationally representative sample of 3921 participants who responded to psychosocial questionnaires in both waves and answered questions about perceived everyday discrimination and attributions of discrimination in 2008.

Results: Changes in perceived discrimination was significantly associated with changes in depressive symptoms over time. Perceived age discrimination was significantly related to a change in depressive symptoms over four years and self-perceptions of aging mediated the relationship between perceived age discrimination and depressive symptoms.

Conclusion: Findings demonstrate the importance of recognizing perceived discrimination and negative self-perceptions of aging as well as how the negative effects of age discrimination on self-perceptions of aging can be risk factors for the development of depressive symptoms in late life.     

Personality traits and escitalopram treatment outcome in major depression

Background: Selective serotonin re-uptake inhibitors (SSRI) have proven to be effective in treatment of depression. Still, treatment efficacy varies significantly from patient to patient and about 40% of patients do not respond to initial treatment. Personality traits have been considered one source of variability in treatment outcome.

Aim: Current study aimed at identifying specific personality traits that could be predictive of treatment response and/or the dynamics of symptom change in depressive patients.

Method: In a sample of 132 outpatients with major depressive disorder (MDD) treated with an SSRI-group antidepressant escitalopram, the Swedish universities Scales of Personality (SSP) were used in order to find predictive personality traits. For the assessment of the severity of depressive symptoms and the improvement rates, the Hamilton Depression Scale (HAM-D) and Montgomery-Åsberg Depression Rating Scale (MADRS) were used.

Results: Escitalopram-treated MDD patients with higher social desirability achieved more rapid decrease in symptom severity. None of the studied traits predicted the end result of the treatment.

Conclusion: The findings suggest that specific personality traits may predict the trajectory of symptom change rather than the overall improvement rate.     

Physical occupational exposures during working life and quality of life after labour market exit: results from the GAZEL study

Objective: To investigate variations in quality of life at older ages, we take a life course perspective to analyse long-term effects of physical working conditions upon quality of life after retirement. In doing so, we study to what extent these associations are explained by individuals’ health at older ages.

Method: We use administrative data and self-administered questionnaire responses from the French GAZEL cohort. Quality of life was assessed with CASP-19 in 2009 and related to three types of physical working conditions during previous working life: (1) ergonomic strain, (2) physical danger and (3) exposures to chemicals. Health was assessed in 2007 with the SF-36 Health Survey. Multiple regressions were calculated in retired men only, controlling for important confounders including social position.

Results: In contrast to men, few women were exposed to strenuous and dangerous working conditions in this cohort and were not included in subsequent analyses. Negative effects on retired men's quality of life were found for the physical occupational exposures of ergonomic strain and physical danger, but not for chemical exposures. Effects were attenuated after the introduction of physical and mental health to the models, indicating an indirect effect of physical working conditions upon quality of life via health.

Conclusion: Adverse physical working conditions have long-term consequences for health and quality of life at older ages. Improvements to physical working conditions may improve individuals’ quality of life over the long term.     

Resilience,stress, and life quality in older adults living with HIV/AIDS

Objectives: This study tested the mediating effect of resilience on the relationship between life stress and health-related quality of life (HRQoL) in older people, 50 years of age and older, living with HIV/AIDS (OPLWHA).

Method: Data from 299 OPLWHA were analyzed using structural equation modeling (SEM) to define a novel resilience construct (represented by coping self-efficacy, active coping, hope/optimism, and social support) and to assess mediating effects of resilience on the association between life stress and HRQoL (physical, emotional, and functional/global well-being).

Results: SEM analyses showed satisfactory model fit for both resilience and mediational models, with resilience mediating the associations between life stress and physical, emotional, and functional/global well-being.

Conclusion: Resilience may reduce the negative influence of life stress on physical, emotional, and functional/global well-being in OPLWHA. Interventions that build personal capacity, coping skills, and social support may contribute to better management of HIV/AIDS and increase HRQoL.     

Agreement between physicians and liaison psychiatrists on depression in old age patients of a general hospital: influence of symptom severity,age and personality

Objective: Comorbid depressive episodes are common among general hospital inpatients. However, existing evidence shows that depression is often poorly recognized in patients aged over 60 years. The aim of the study was first to determine the degree of agreement between primary care physicians' and liaison psychiatrists' evaluation of depression, and second, to analyze how patients' clinical presentation and personality traits influence this degree of agreement.

Methods: Agreement was defined as the matching of the physicians' initial referral for depressive mood and the actual diagnosis of a major depressive disorder evaluated by the consultation–liaison service in 148 inpatients aged 60+ years. Nature and severity of psychiatric symptoms were rated on the HoNOS65+ scale and patients' personality traits were assessed with the Big Five Inventory.

Results: Forty percent of the patients referred for depressive mood were indeed diagnosed with major depression. Agreement between physicians and psychiatrists was most likely in patients with more severe depressive symptoms and younger age. In contrast, risk for non-agreement was increased for patients with more open personalities, yet lower levels of neuroticism, who were referred for depressive mood even though they presented another or even no psychiatric disorder.

Conclusion: These data reveal that the detection of late-life depression in general hospitals may be critically influenced by age, symptoms severity and personality traits.     

Stress on health-related quality of life in older adults: the protective nature of mindfulness

Objectives: The current study examined whether the link between stress and health-related quality of life was buffered by protective factors, namely mindfulness, in a sample of middle-aged and older adults.

Methods: In this cross-sectional study, 134 healthy, community-dwelling adults (ages 50–85 years) were recruited from Dallas, TX. The participants were screened for depressive symptoms and severity (using the Patient Health Questionnaire [PHQ-9]). All participants completed measures of self-reported health status (i.e. SF36v2: mental and physical health composites), life stress (using the Elders Life Stress Inventory [ELSI]), and trait mindfulness (i.e. Mindful Attention Awareness Scale).

Results: Hierarchical regressions (covarying for age, gender, and education) showed that life stress was inversely related to physical and mental health. Mindfulness was positively related to mental health. The negative effect of life stress on mental health was weakened for those individuals with higher levels of trait mindfulness.

Conclusions: The results suggest that mindfulness is a powerful, adaptive strategy that may protect middle-aged and older adults from the well-known harmful effects of stress on mental health.     

Schema therapy for personality disorders in older adults: a multiple-baseline study

Objective: No studies have been conducted yet into the effectiveness of treatment of personality disorders in later life. This study is a first test of the effectiveness of schema therapy for personality disorders in older adults.

Method: Multiple-baseline design with eight cluster C personality disorder patients, with a mean age of 69. After a baseline phase with random length, schema therapy was given during the first year, followed by follow-up sessions during six months. Participants weekly rated the credibility of dysfunctional core beliefs. Symptomatic distress, early maladaptive schemas, quality of life and target complaints were assessed every six months and personality disorder diagnosis was assessed before baseline and after follow-up. Data were analyzed with mixed regression analyses.

Results: Results revealed significant linear trends during treatment phases, but not during baseline and follow-up. The scores during follow-up remained stable and were significantly lower compared to baseline, with high effect sizes. Seven participants remitted from their personality disorder diagnosis.

Conclusion: Schema therapy appears an effective treatment for cluster C personality disorders in older adults. This finding is highly innovative as this is the first study exploring the effectiveness of psychotherapy, in this case schema therapy, for personality disorders in older adults.     

Do depressive symptoms predict mortality in older people?

Context: Depressive symptoms are common in older persons, and may predict mortality.

Objectives: To determine: (1) If depressive symptoms predict mortality; (2) If there is a gradient in this effect; and (3) Which depressive factors predict mortality.

Population: In 1991–1992, 1751 community-dwelling older persons, sampled from a population-based registry, were interviewed.

Measures: The Center for Epidemiologic Studies – Depression (CES-D), age, gender, the Modified Mini-Mental State Examination, self-rated health, and functional status.

Outcome measure: Time to death.

Analysis: Those scoring 16+ on the CES-D were considered depressed. To determine if a gradient was present, the CES-D was treated as a continuous variable. Four depressive factors from the CES-D (depressed affect, positive affect, somatic, and interpersonal) were analyzed. Cox regression models were constructed.

Results: The mortality in those with depressive symptoms was higher in those without depressive symptoms (Hazard Ratio of 1.71, p < 0.001, Log rank test). In multivariable models, this association was no longer significant after accounting for self-rated health and functional status. There was a gradient in risk of mortality across the range of the CES-D. Somatic factors, depressed affect, and positive affect were all associated with mortality in bivariate analyses, but not in multivariable models adjusting for functional status. Interpersonal factors were not associated with mortality.

Conclusions: Depressive symptoms predict mortality in older persons.     

Possible error in the Danish version of the WHO Quality of Life (WHOQOL-BREF) Questionnaire

Background: The WHOQOL-BREF is widely used to measure quality of life.

Aims: The goal of the present study was to use the questionnaire in a doctoral study.

Methods: We studied all the instructions provided by the WHO.

Results: In the Danish version of the WHOQOL-BREF there is a discrepancy between the negatively phrased question 9 and both the syntax file and the verbal instructions for coding the data provided by the WHO.

Conclusions: This is a notification of possible error interpretations in projects that use the questionnaire. This could be corrected by manual correction in the coding process or by changing the negatively phrased question 9.     

Urban and rural factors associated with life satisfaction among older Chinese adults

Objective: This study compared urban and rural factors associated with life satisfaction among older adults in mainland China.

Method: Study data were extracted at random from 10% of the Sample Survey on Aged Population in urban/rural China in 2006 for 1980 participants aged 60 and older, including 997 from urban cities and 983 from rural villages.

Results: In this study, 54.6% of urban older adults and 44.1% of rural older adults reported satisfaction with their lives. Binary logistic regression analysis showed that financial strain, depressive symptoms, filial piety, and accessibility of health services were significantly associated with life satisfaction for both urban and rural participants, but age and financial exchange with children were only associated with life satisfaction among urban older adults.

Conclusion: Findings are consistent with some previous studies that indicated the importance of financial strain, depressive symptoms, filial piety, and accessibility of health services to life satisfaction among the older adults in both urban and rural areas. This study also demonstrated the importance of age and family financial exchange to the life satisfaction of urban older adults.     

Pathways from fear of falling to quality of life: the mediating effect of the self-concept of health and physical independence

Objectives: Fear of falling leads to many adverse consequences and may compromise the quality of life of older adults. Psychological factors are potential mediators between the fear of falling and quality of life, but have yet to be explored in detail. This study presents results from examining the mediating effect of the self-concept of health and physical independence. Data from Western and Eastern countries were compared.

Method: Concerns about falling, the level of participation in physical activities, the self-concept of health and physical independence, and health-related quality of life were measured using samples from Taiwan (n = 193) and Germany (n = 182). Multiple regression models were used to test the mediating effects.

Results: The relationship between fear of falling and quality of life was partially mediated through participation in physical activities and the self-concept of health and physical independence in both the Taiwanese and German samples. In particular, the self-concept of health and physical independence of the Taiwanese sample resulted in the strongest mediating effect.

Conclusion: Potential mediating mechanisms through both participation in physical activities and the self-concept of health and physical independence provide useful information for understanding related theories and for explicating interventions. Cultural factors should also be accounted for when conducting research and programs related to the fear of falling.     

Patient reported outcome measures (PROMs): examination of the psychometric properties of two measures for burden of symptoms and quality of life in patients with depression or anxiety

Introduction: Patient-reported outcome measures (PROMs) for anxiety and depressive disorders are an important aspect of measurement-based care.

Aim: The aim of the study was to perform a clinimetric analysis of two PROMs scales in patents with depression and anxiety.

Methods: Patients completed a 10-item version (SCL-10) of the Symptom Checklist to measure burden of symptoms and a brief 5-item version of World Health Organization Well-being scale (WHO-5) to measure quality of life. T-scores were used to standardize the SCL-10 and WHO-5 in terms of being in need of treatment. The coefficient of alpha and the coefficient of homogeneity were used to evaluate the internal consistency or scalability respectively of SCL-10 and WHO-5. Effect size statistics and Spearman correlation coefficients were used to measure the effect of gender and age, respectively.

Results: A total of 801 patients were recruited from two Danish mental health centers with anxiety or depression. The standardization of the SCL-10 and WHO-5 by T-scores indicated that a T-score of 65 corresponding to being moderately in need of treatment and a T-score of 75 to be severely in need of treatment. The coefficient of alpha and the coefficient of homogeneity were both found acceptable for SCL-10 and WHO-5. No gender or age factors were found being in operation.

Conclusion: The results from the current study supported the use of the SCL-10 and WHO-5 as potential PROMs to capture symptom burden and quality of life within groups of people with anxiety or depression undergoing psychotherapy treatment.     

The predicament of time near the end of life: Time perspective trajectories of life satisfaction among the old-old

Objective: The present study investigated time perspective in old-old age as embodied in trajectories of life satisfaction ratings that individuals attribute to their past, present, and anticipated future. We hypothesized that these trajectories represent diverse strategies of coping with old age.

Method: The sample was composed of 164 participants (mean age 91.9, SD = 4.3) who survived the third wave of a national longitudinal study in Israel. The findings indicated four groups; three with distinctive trajectories of life satisfaction – equilibrated, descending, and no-future, along with an unreported trajectory group.

Results: The equilibrated trajectory group exhibited the highest functioning on central markers of adaptation (indicating depressive symptoms, self-rated health, and physical performance). The descending and the no-future trajectories were found to be moderately effective strategies. The unreported trajectory presented the lowest level of functioning.

Conclusions: The findings revealed the adaptive roles of time-related perspective on life in old-old people. This perspective reflects a variety of rudimentary trajectories that constitute a time-based module of well-being along the continuum of one's life story. The study suggests that the diverse trajectories relate to essential domains of functioning. Practitioners and therapists may profit from assessing the time perspective of the old-old and directing it into more adaptive trajectories.     

Autonomy and social functioning of recently admitted nursing home residents

Objectives: This paper examines recently admitted nursing home residents’ practical autonomy, their remaining social environment and their social functioning.

Method: In a cross-sectional design, 391 newly admitted residents of 67 nursing homes participated. All respondents were ≥65 years old, had mini-mental state examination ≥18 and were living in the nursing home for at least 1 month. Data were collected using a structured questionnaire and validated measuring tools.

Results: The mean age was 84, 64% were female, 23% had a partner, 80% children, 75% grandchildren and 59% siblings. The mean social functioning score was 3/9 (or 33%) and the autonomy and importance of autonomy score 6/9 (or 67%). More autonomy was observed when residents could perform activities of daily living more independently, and cognitive functioning, quality of life and social functioning were high. Residents with depressive feelings scored lower on autonomy and social functioning compared to those without depressive feelings. Having siblings and the frequency of visits positively correlated with social functioning. In turn, social functioning correlated positively with quality of life. Moreover, a higher score on social functioning lowered the probability of depression.

Conclusion: Autonomy or self-determination and maintaining remaining social relationships were considered to be important by the new residents. The remaining social environment, social functioning, quality of life, autonomy and depressive feelings influenced each other, but the cause--effect relation was not clear.     

Positive attitude toward life,emotional expression,self-rated health,and depressive symptoms among centenarians and near-centenarians

Objectives: Favorable attitudes, emotions, personality characteristics, and self-rated health have been associated with successful aging in late life. However, less is known regarding these constructs and their relationships to mental health outcomes in the oldest old persons. This study examined cross-sectional relationships of these psychological factors to depressive symptoms in centenarians and near-centenarians.

Methods: A selected sample of Ashkenazi Jewish older adults aged 98–107 (n = 54, 78% female) without significant cognitive impairment participated. Cognitive function was assessed by Mini-Mental Status Examination, positive attitude toward life and emotional expression by the Personality Outlook Profile Scale (POPS), self-rated health by participants' subjective rating of their present health, and depressive symptoms by the Geriatric Depression Scale.

Results: Results demonstrated inverse associations of the positive attitude toward life domain of the POPS and self-rated health with participants' levels of depressive symptoms even after adjusting for the effects of history of medical illnesses, cognitive function, and demographic variables. Additionally, participants with high levels of care showed higher levels of depressive symptoms. Path analysis supported the partially mediating role of positive attitude toward life in the relationship between self-rated health and depressive symptoms.

Conclusion: These findings emphasized the important roles of positive attitudes and emotions as well as self-rated health in mental health outcomes in the oldest old. Although, limited by its cross-sectional design, findings suggest these psychological factors may exert protective effects on mental health outcomes in advanced age.     

Spirituality attenuates the association between depression symptom severity and meaning in life

Objectives: This cross-sectional study examined whether spirituality moderates the association between depression symptom severity and meaning in life among treatment-seeking adults.

Method: Participants were 55 adults (≥60 years of age) newly seeking outpatient mental health treatment for mood, anxiety, or adjustment disorders. Self-report questionnaires measured depression symptom severity (Patient Health Questionnaire-9), spirituality (Spirituality Transcendence Index), and meaning in life (Geriatric Suicide Ideation Scale-Meaning in Life subscale).

Results: Results indicated a significant interaction between spirituality and depression symptom severity on meaning in life scores (β = .26, p = .02). A significant negative association between depression symptom severity and meaning in life was observed at lower but not the highest levels of spirituality.

Conclusion: In the presence of elevated depressive symptomatology, those participants who reported high levels of spirituality reported comparable levels of meaning in life to those without elevated depressive symptomatology. Assessment of older adult patients’ spirituality can reveal ways that spiritual beliefs and practices can be can be incorporated into therapy to enhance meaning in life.     

Life-crossroads on stage: integrating life review and drama therapy for older adults

Objective: This paper examines the contribution of a new group of therapeutic interventions for older adults, based on a rudimentary life-review intervention.

The intervention includes narrative elements together with drama therapy. The current study examines the influence of this therapeutic intervention on key indicators of mental health and psychological well-being among older adults.

Method: Fifty-five people (n = 55), ranging in age from 62 to 93, participated in a before–after study design. The following indices – meaning in life, self-acceptance, relationships with others, depressive symptoms, and experience of successful aging – were compared between an intervention group (n = 27) and a care-as-usual control group (n = 28).

Results: Repeated measures analyses of variance showed a significant improvement over time in the experimental group. In addition, results also showed time-group interaction regarding the treatment's effectiveness for self-acceptance, relationships with others, sense of meaning in life, sense of successful aging, and depressive symptoms.

Conclusion: Our findings confirm that the new therapeutic intervention, which integrates life-review with drama therapy, increases self-acceptance, relationships with others, sense of meaning in life, and sense of successful aging; in turn, it also decreases depressive symptoms among older adults. The contribution of this research is based on the development of a therapeutic intervention that combines narrative together with drama therapy tools, which can be used in focused and short-term group treatments with the elderly.     

Does social desirability influence psychological well-being: perceived physical health and religiosity of Italian elders? A developmental approach

Objective: This study was mainly aimed at exploring the relationship between psychological well-being and lifestyle, religion, perceived physical health and social desirability of Italian elders.

Methods: Four hundred and six cognitively healthy 65–99 years old participants were recruited from the Italian isle of Sardinia, where a high prevalence of centenarians is registered. Participants were presented with several tools assessing psychological well-being, lifestyle, social desirability, religiosity and subjective physical health.

Results: A hierarchical regression analysis revealed that the social desirability measure is the best predictor of general subjective well-being, whereas further predictors are age, perceived physical health and gardening. A significant but moderate relationship was also found between psychological well-being, subjective physical health and religiosity, while controlling for social desirability.

Conclusions: Social desirability seems to contaminate the self-rating of psychological well-being in late adulthood. Moreover, from a developmental perspective, age-related factors, life style and perceived physical health are strictly related to and therefore influence the perception of life quality in the third and fourth age.     

Felt age and cognitive-affective depressive symptoms in late life

Objectives: This study examined both cross-sectional and longitudinal relationships between felt age and cognitive-affective symptom dimensions of depression in late life.

Method: Data for this study came from two interview waves (T1 and T2) of the National Health and Aging Trend Study. Sample persons (n = 6680) who resided in their own or another's home at T1 were included. At T2 (one year later), 5414 of the original 6680 were interviewed and depressive symptom data were available for 5371 sample persons. The associations between felt age and depressive symptoms were analyzed using stepwise linear regression analyses.

Results: At T1, (1) more than 70% of the sample felt younger and 7% felt older than their chronological age; and (2) younger felt age was associated with lower depressive symptoms, and older felt age was associated with higher depressive symptoms. Controlling for T1 depressive symptoms and health conditions, older felt age at T1 also predicted higher depressive symptoms at T2; however, chronological age and felt age explained only a small amount of variance in depressive symptom scores.

Conclusion: The self-enhancement or self-protection function of younger felt age at T1 does not appear to extend longitudinally to T2, while the negative depressive effect of older felt age at T1 extends to T2.